Buzkova Kristyna, Muller Martin, Rara Ales, Roubik Karel, Tyll Tomas
Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical Universty in Prague, Czech Republic.
Department of Anesthesiology, Resuscitation and Intensive Care Medicine First Faculty of Medicine Charles University and the Military University Hospital Prague, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018 Mar;162(1):43-46. doi: 10.5507/bp.2018.005. Epub 2018 Feb 21.
During laparoscopic surgery, a capnoperitoneum is created to optimize the operating space for surgeons. One effect of this is abdominal pressure which alters the physiological thoraco-abdominal configuration and pushes the diaphragm and lungs cranially. Since the lung image acquired by electrical impedance tomography (EIT) depends on the conditions within the thorax and abdomen, it is crucial to know the diaphragm position to determine the effect of diaphragm shift on EIT thorax image.
The presence of diaphragm in the region of EIT measurement was determined by ultrasound in 20 patients undergoing laparoscopic surgery. Data were obtained in the supine position during spontaneous breathing in a mechanically ventilated patient under general anesthesia with muscle relaxation and in a mechanically ventilated patient under general anesthesia with muscle relaxation during capnoperitoneum.
The diaphragm was shifted cranially during capnoperitoneum. The diaphragm detection rate rose by 10% during capnoperitoneum at the fifth intercostal space, from 55% to 65% and by 10% from 0% at mid-sternal level compared to mechanical ventilation without capnoperitoneum.
The diaphragm was detected in the area contributing to the creation of the thoracic EIT image. Considering the cranial shift of diaphragm caused by excessive intra-abdominal pressure, the impedance changes in the abdomen and the principle of EIT, we assume there could be a significant impact on EIT image of the thorax acquired during capnoperitoneum. For this reason, for lung monitoring using EIT during capnoperitoneum, the manufacturer's recommendation for electrode belt position is not appropriate. The study was registered in ClinicalTrials.gov with an identifier NCT03038061.
在腹腔镜手术期间，需建立气腹以优化外科医生的操作空间。这样做的一个影响是腹压，它会改变生理上的胸腹结构，并将膈肌和肺向上推。由于通过电阻抗断层成像（EIT）获取的肺部图像取决于胸腹部的状况，了解膈肌位置对于确定膈肌移位对EIT胸部图像的影响至关重要。
通过超声确定20例接受腹腔镜手术患者的EIT测量区域内膈肌的存在情况。数据是在全身麻醉且肌肉松弛的机械通气患者自主呼吸时的仰卧位以及气腹期间全身麻醉且肌肉松弛的机械通气患者中获取的。
气腹期间膈肌向上移位。与无气腹的机械通气相比，在第五肋间间隙，气腹期间膈肌检测率提高了10%，从55%升至65%，在胸骨中线水平从0%提高了10%。
在对创建胸部EIT图像有贡献的区域检测到了膈肌。考虑到腹内压过高导致膈肌向上移位、腹部的阻抗变化以及EIT的原理，我们认为气腹期间获取的胸部EIT图像可能会受到显著影响。因此，对于气腹期间使用EIT进行肺部监测，制造商对电极带位置的建议并不合适。该研究已在ClinicalTrials.gov上注册，标识符为NCT03038061。
